teamwork and communication working within the behavioral ...€¦ · iom report . t. eam. stepps®...

Teamwork and communication working within the Behavioral Health system

Robert S. Steele, MD, FAAFP

Bree Watzak PharmD, BCPS

A&M Rural and Community Health Institute (ARCHI)

Texas A&M University – College of Medicine

TEAMSTEPPS 05.2Mod 1 2.0

Introduction

3

Teamwork ExerciseSetting the Stage

Think of a team you have been on that was high-functioning. What were the characteristics of that

team?


Introduction

4

Objectives

Describe the impact of errors and why they occur

Describe the TeamSTEPPS framework

State the outcomes of the TeamSTEPPS framework


Introduction

Core Teamwork Skills

5


Introduction

6

Just a Routine Operation

https://www.youtube.com/watch?v=JzlvgtPIof4

Sue SheridanLg001.mpg

https://www.youtube.com/watch?v=JzlvgtPIof4


Introduction

7

Video Discussion

What breakdowns in teamwork did you observe in the stories?

How can we prevent medical errors?

How can we continue to improve communication with all those we work with?


Introduction

8

Barriers to Team Performance

Inconsistency in team membership

Lack of time

Lack of information sharing

Hierarchy

Defensiveness

Conventional thinking

Varying communication styles

Conflict

Lack of coordination and followup

Distractions

Fatigue

Workload

Misinterpretation of cues

Lack of role clarity


Introduction

Patient Safety Movement & Team Training

Patient Safety

and Quality

Improvement

Act of 2005

Executive

Memo from

President

DoD

MedTeams®

ED Study

Institute for

Healthcare

Improvement

100K lives

Campaign

“To Err

Is Human”

IOM Report TeamSTEPPS®

1995 1999 2001 2003 2004 2005

JCAHO National

Patient Safety

Goals

2006

TeamSTEPPS

Released to the

Public

2007

TeamSTEPPS

National

Implementation

Program Began

2008

National

Implementation

of CUSP

Centers for

Medicare &

Medicaid Services

Partnership for

Patients Campaign

2011

Medical Team Training


Introduction

10

Team Strategies & Tools to Enhance Performance & Patient Safety

Based on more than 30 years of research and evidence

Team training programs have been shown to improve attitudes, increase knowledge, and improve behavioral skills

Salas, et al. (2008) meta-analysis provided evidence that team training had a moderate, positive effect on team outcomes (ρ = .38)


Introduction

11

What Makes Up Team Performance?

Knowledge

Cognitions

“Think”

Attitudes

Affect

“Feel”

Skills

Behaviors

“Do”


Introduction

12

Outcomes of Team Competencies

Knowledge Shared Mental Model

Attitudes Mutual Trust Team Orientation

Performance Adaptability Accuracy Productivity Efficiency Safety


Introduction

Evidence That TeamSTEPPS Works

13

Capella, et al. (2010)

Trauma resuscitation team implementation

Pre- and post-TeamSTEPPS training results:

Team performance improved across all teamwork skills: Leadership, Situation Monitoring, Mutual Support, Communication

Significantly decreased times from arrival to CT scanner, endotracheal intubation, and operating room

Thomas & Galla (2013)

Systemwide implementation

Pre- and post-TeamSTEPPS training results:

Significant improvement in HSOPS scores on Feedback and Communication AboutError, Frequency of Events Reported, Hospital Handoffs and Transitions, and Teamwork Across Units

Incremental changes evident through reduction of nosocomial infections, falls, birth trauma, and other incidents

Team Structure, Leadership, & Communication

NEXT:


Introduction

15

Objectives

Discuss benefits of teamwork and team structure

Define a “team”

Identify the role of patients and their families as part of the care team

Describe the components and composition of a multi-team system

Describe how communication affects team outcomes

Identify TeamSTEPPS tools and strategies that can improve team communication


Introduction

Team Structure

Teamwork cannot occur in the absence of a clearly defined team

Understanding a team’s structure and how multiple teams interact is critical for implementation planning

16


Introduction

17

Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and may have a time-limited membership

What Defines a Team?


Introduction

18

Exercise: Teams and Teamwork

1. What is the GOAL of your unit or work area?

2. Are you a group or a team?

3. What characteristics make you a team or are what should you do to become a team?


Introduction

19

Partnering With the Patient

Strategies for involving patients in their care

Include patients in bedside rounds

Conduct handoffs at the patient’s bedside

Provide patients with tools for communicating with their care team

Involve patients in key committees

Actively enlist patient participation


Introduction

20

Clinical Team Responsibilities

Embrace patients and their families as valuable and contributing partners in patient care

Listen to patients and their families

Assess patients’ preference regarding involvement

Ask patients about their concerns

Speak to them in lay terms

Allow time for patients and families to ask questions

Ask for their feedback

Give them access to relevant information

Encourage patients and their families to proactively participate in patient care


Introduction

Patient and Family Responsibilities

Provide accurate patient information

Comply with the prescribed plan of care (e.g., schedule and attend appointments as directed)

Ask questions and/or voice any concerns regarding the plan of care

Monitor and report changes in the patient’s condition

Manage family members

Follow instructions of the clinical team

21


Introduction

22

Multi-Team System (MTS) for Patient Care


Introduction

23

Core Team members have the closest contact with

the patient!

A Core Team is…

A group of care providers

who work interdependently

to manage a set of

assigned patients

from point of

assessment to

disposition


Introduction

24

A time-limited team formed

for emergent or specific

events and composed

of members from

various teams

A Contingency Team is…


Introduction

25

A team comprising those

work area members who are

responsible for managing

the operational

environment that

supports the

Core Team

A Coordinating Team is…


Introduction

26

Ancillary Services provide direct, task-specific, time-limited care to patients.

Support Services provide

indirect service-focused tasks

which help to facilitate the

optimal health care experience

for patients and their families.

Ancillary & Support Services


Introduction

27

Establish and communicate vision

Develop policies and set expectations for staff related to teamwork

Support and encourage staff during implementation and culture change

Hold teams accountable for team performance

Define the culture of

the organization

The Role of Administration is to…


Introduction

28

Team Structure Video

https://www.youtube.com/watch?time_conti

nue=5&v=bO2HHEWDD3w

http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/videos/ts_STEPINPTMED/STEPINPTMED-400-300.html

https://www.youtube.com/watch?time_continue=5&v=bO2HHEWDD3w


Introduction

29

Team Structure Video Analysis

What breakdowns could occur between the components of this multi-team system?

What could have been done to ensure a positive outcome?


Introduction

30

High-Performing Teams

Teams that perform well:

Hold shared mental models

Have clear roles and responsibilities

Have clear, valued, and shared vision

Optimize resources

Have strong team leadership

Engage in a regular discipline of feedback

Develop a strong sense of collective trust and confidence

Create mechanisms to cooperate and coordinate

Manage and optimize performance outcomes

(Salas et al. 2004)

Communication

Assumptions

Fatigue

Distractions

HIPAA

http://mx.ha.osd.mil/FileDir/7dfd63a3-415d-451f-8056-0aaea4cca38f/Module 5-05.1-Communication.ppt


Introduction

Video: Lost in Translation (Berlitz Coast Guard)

32

http://www.youtube.com/watch?v=yR0lWICH3rY

http://www.youtube.com/watch?v=yR0lWICH3rY


Introduction

33

Communication

Effective communication skills are vital for patient safety

Enables team members to effectively relay information

The mode by which most TeamSTEPPS strategies and tools are executed


Introduction

34

Importance of Communication

Joint Commission data continues to demonstrate the importance of communication in patient safety

1995 - 2005: Ineffective communicationidentified as root cause for nearly 66 percent of all reported sentinel events*

2010 - 2013: Ineffective communication among top 3 root causes of sentinel events reported**

* (JC Root Causes and Percentages for Sentinel Events (All Categories) January 1995−December 2005)

** (JC Sentinel Event Data (Root Causes by Event Type) 2004-2012)

Teamwork Exercises


Introduction

BREAKING NEWS!!


Introduction

Tater Trauma Your team has been tasked with reassembling MVA victims

Roles include:

Triage (has photos of patients)

Whatever other roles the team feels is needed

Rules:

Only Triage can see the pictures of the patients and must relay this information to the rest of the team

Triage cannot see what the team is doing (back turned toward the group)

Triage may not change roles once time starts because they will have seen the pictures

You have 1 minute to select roles

You will have 12 minutes to put your patients back together


Introduction

Picture Story Teamwork Exercise

DO NOT turn over or look at the piece of paper until you are told to do so.

You are all members of one big team. Each of you have been given a part of a picture story. The pictures are all connected to each other in sequence. Please practice your teamwork/communication skills and put the pictures in correct order.

Rules: You can talk about your picture but cannot show it to others. Hide your picture from others and please do not look at anyone else’s pictures.


Introduction

39

Shared understanding

The process by which information is exchanged

The lifeline of the Core Team

Effective when itpermeates every aspect of an organization

Communication is…

Assumptions

Fatigue

Distractions

HIPAA


Introduction

Shared understanding?

https://www.youtube.com/watch?v=_Dj_sZt

CVPc

https://www.youtube.com/watch?v=_Dj_sZtCVPc


Introduction

41

Body Language

In face-to-face communication:

Words: 7% of meaning

Tone of voice: 38%

Body language: 55%

Visual Cues

Such as color coding

Non-verbal Communication


Introduction

42

Brief Clear

Timely


Introduction

43

Communication Challenges

Language barrier

Distractions

Physical proximity

Personalities

Workload

Varying communication styles

Conflict

Lack of information verification

Shift change


Introduction

Video: Communication Challenges (Lighthouse vs. Destroyer)

https://www.youtube.com/watch?v=cAsT4sb8d9M

44

https://www.youtube.com/watch?v=cAsT4sb8d9M


Introduction

45

Four Information Exchange Strategies

Situation – Background – Assessment –Recommendation (SBAR)

Call-Out

Check-Back

Handoffs


Introduction

46

#1: SBAR Provides…

A framework for team members to effectively communicate information to one another

Communicate the following information:

Situation―What is going on?

Background―What is the background or context?

Assessment―What do I think the problem is?

Recommendation―What would I recommend?


Introduction

47

Example SBAR

Situation―What is going on?

Background―What is the background or context?

Assessment―What do I think the problem is?

Recommendation―What would I recommend?


Introduction

48

#2: Call-Out is…

A strategy used to communicate important or critical information

It informs all team members simultaneously during emergency situations

It helps team members anticipate next steps

http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/videos/ts_ldcallout/callout2.html


Introduction

49

#3: Check-Back is…

http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/videos/ts_checkback/checkback.html


Introduction

Check Back

https://www.youtube.com/watch?v=mLFZT

zR5u84

https://www.youtube.com/watch?v=mLFZTzR5u84


Introduction

#4: Handoff is… The transfer of information during transitions in

responsibility across the continuum

Includes an opportunity to ask questions, clarify, and confirm

51


Introduction

Handoff Consists of…

Transfer of responsibility and accountability

Clarity of information

Verbal communication of information

Acknowledgment by receiver

Opportunity to review

52

http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/videos/ts_ISHandoff/INPTSURG-768.html

Leadership


Introduction

54

Types of Team Leaders

Designated – The person assigned to lead and organize a team, establish clear goals, and facilitate open communication and teamwork among team members

Situational – Any team member who has the skills to manage the situation at hand


Introduction

55

Define, assign, share, monitor, and modify a plan

Review the team’s performance

Establish “rules of engagement”

Manage and allocate resources effectively

Provide feedback regarding assigned responsibilities

and progress toward the goal

Facilitate information sharing

Encourage team members to assist one another

Facilitate conflict resolution

Model effective teamwork

Effective Team Leaders


Introduction

When to share

Brief: short session before you start to share the plan

Huddle: ad hoc meeting to monitor & modify the plan

Debrief: after you are done, informal session to review team performance. What went well and what can we do better next time. NOT a vent session


Introduction

57

When:

Briefs

Huddles

Debriefs

When and How to Share information?

How:

SBAR

Call-outs

Check-backs


Introduction

58

Tools & Strategies Summary

TOOLS and STRATEGIES

Communication

• SBAR

• Call-Out

• Check-Back

• Handoff

Leading Teams

• Brief

• Huddle

• Debrief

OUTCOMES

Shared Mental Model

Adaptability

Team Orientation

Mutual Trust

Team Performance

Patient Safety!!

BARRIERS Inconsistency in Team

Membership

Lack of Time

Lack of Information Sharing

Hierarchy

Defensiveness

Conventional Thinking

Complacency

Varying Communication Styles

Conflict

Lack of Coordination and Followup With Coworkers

Distractions

Fatigue

Workload

Misinterpretation of Cues

Lack of Role Clarity


Introduction

Questions?

teamwork and communication working within the behavioral ...€¦ · iom report . t. eam. stepps®...

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